Urticaria de contacto por Aloe vera / Contact urticaria by Aloe vera

El Aloe vera es un producto ampliamente usado en alimentación y cosmética. Aunque es considerado una planta medicinal por sus múltiples propiedades, no es un producto inocuo, ya que presenta ciertos componentes irritantes que pueden producir efectos secundarios. La dermatitis alérgica de contacto se presenta entre los mismos. Presentamos el caso de un niño de seis años en el que observamos una urticaria tras la aplicación directa del jugo de la planta de Aloe, con buena respuesta al tratamiento convencional de la urticaria. Tras esta revisión bibliográfica, podemos concluir que no puede recomendarse el uso de Aloe vera para el tratamiento de ninguna patología específica debido a que no existe suficiente evidencia de su eficacia en la práctica clínica (AU)

Aloe vera is a widely used product in the food sector and the cosmetics industry. Although it is considered to be a medicinal plant because of its many properties, it is not an innocuous product as it has certain irritating components which can cause side effects. Allergic contact dermatitis is included among them. We present the case of a six-year-old child who shows urticaria after applying the juice of the Aloe plant directly onto the skin. The patient responded successfully to conventional urticaria treatment. After this literature review we can conclude that the use of Aloe vera cannot be recommended for the treatment of any specific pathology since there is not enough evidence to prove the effectiveness in clinical practice (AU)

Eficacia de un programa intensivo de terapia ocupacional para niños amputados / Efficacy of an intensive occupational therapy programme for amputated children

Objetivo: Analizar si los niños con prótesis mioeléctricas pueden mejorar sus destrezas motoras necesarias para la realización de las actividades de la vida diaria (AVD) de manera independiente. Material y método: Se realizó un programa estructurado de terapia ocupacional, basado en actividades de coordinación motora fina y gruesa, así como un refuerzo constante de las AVD, durante 6 días en 10 niños amputados (4 chicos y 6 chicas) usuarios de prótesis mioeléctricas, con edades comprendidas entre 4-0 años. Se administró el Assessment of Process and Motor Skills (AMPS) para evaluar las destrezas motoras al inicio y al finalizar la estancia en el campamento. Resultados: En la primera valoración y en la segunda obtuvieron respectivamente los siguientes resultados por destrezas: alcanza (2,0-1,4), se inclina (1,8-1,2), manipula (2,1-1,6), coordina (2,3-2,0), mueve (2,1-1,7), posiciona (2,0-1,7), camina (1,2-1,1), transporta (1,7-1,6). Todos los participantes mejoraron en las habilidades referidas a la posición corporal, obtener y sujetar objetos, y movilización de si mismos y de los objetos. Conclusiones: Los programas intensivos de terapia ocupacional en los niños usuarios de prótesis mioeléctricas son eficaces, ya que mejoran la calidad en la realización de las AVD lo que redunda en la mejora de la autoestima y en la calidad de vida de los niños (AU)

Objective: To analyse myoelectric prostheses in amputated children on fulfilling activities of daily life (ADL) independently. Material and method: A structured occupational therapy programme was performed, based on fine and gross motor coordination activities as well as constant reinforcement of ADL for 6 days in 10 amputated children (4 boys and 6 girls) using myoelectric prostheses, aged within 4-0 years. The Assessment of Process and Motor Skills (AMPS) was administered to evaluate motor skills at the start and at the end of stay in the camp. Results: The following results were obtained in the first and the second assessment, by skills, respectively: reaches (2.0-1.4), bends (1.8-1.2), manipulates (2.1-1.6), coordinates (2.3-2.0), moves (2.1-1.7), positions (2.0- 1.7), walks (1.2-1.1), carries (1.7-1.6). All participants improved their skills referring to body position, obtaining and holding objects and moving themselves and objects. Conclusion: Invasive occupational therapy programmes in children using myoelectric prostheses are effective, as they improve quality in fulfilling ADL, leading to an improved self-esteem and quality of life of children (AU)

Prevention of stomal recurrence.

BACKGROUND: The authors reviewed the incidence of stomal recurrence (SR) in a population of laryngectomized patients to study associated risk factors and determine the usefulness of certain preventive procedures. METHODS: A retrospective study was performed in 296 patients with larynx and hypopharynx carcinoma treated by total laryngectomy. RESULTS: Of the 296 patients, 6 (2%) were initially seen with SR. In all cases, a risk factor was found to be involved: subglottic extension (5 cases), tracheotomy prior to laryngectomy (1 case). Since 1989, when preventive measures were systematically introduced in patients presenting risk factors, there have been no further cases of SR. The surgical measures in tumors with subglottic extension consisted of hemithyroidectomies, paratracheal lymph node dissection, and extensive tracheal resection; in the case of a tracheotomy prior to the laryngectomy, extensive resections of the tracheal stoma were carried out. CONCLUSIONS: The systematic use of preventive surgical measures together with postoperative radiotherapy to the stoma and superior mediastinum have led to a decrease in the appearance of SR.

Function preservation in stage III squamous laryngeal carcinoma: results with an induction chemotherapy protocol.

Until recently, standard treatment for stage III laryngeal carcinoma (LC) was total laryngectomy and radiotherapy. Recent data suggest that induction chemotherapy (ICH) plays a role in preserving function in advanced head and neck cancer. No reports to date prospectively evaluate ICH exclusively in stage III LC. The authors designed a sequential phase II trial to assess if ICH allowed a conservative treatment in this disease. The objective of the first part of the study was to rule out a complete response rate with ICH below 30% with P < .05. ICH protocol consisted of three courses of cisplatin 100 mg/M2 on day 1 and 5-fluorouracil 5000 mg/M2 continuous infusion over 120 hours. Radiotherapy was administered to patients who attained a complete response (CR). Functional surgery (FS) was planned for patients with partial response. A total laryngectomy followed by radiotherapy was performed when FS was not feasible. Fifty-two previously untreated patients (all males) with squamous stage III LC were diagnosed in our institution, and 46 were entered in the ICH trial. After 9 patients were included, data showed 7 (78%) CR, ruling out a CR rate of less than 30%. After ICH, a CR was achieved in 29 (63%) of 46 patients. At the end of treatment, 35 patients (76%) had a functioning larynx. With a median follow-up of 3 years, larynx function was preserved in 26 (57%) of 46 patients and in 64% of survivors. Four-year actuarial larynx function preservation, overall survival, and disease-free survival were 55%, 77%, and 67%, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Randomized trial of neoadjuvant cisplatin and fluorouracil versus carboplatin and fluorouracil in patients with stage IV-M0 head and neck cancer.

PURPOSE: A randomized trial was designed to compare cisplatin (CDDP) and fluorouracil (FU) versus carboplatin (CBDCA) and FU as neoadjuvant treatment in stage IV-M0 head and neck cancer to assess whether CBDCA-FU is better than CDDP-FU with regard to response and toxicity. PATIENTS AND METHODS: Patients were randomized to receive CDDP 100 mg/m2 intravenously on day 1 and FU 5,000 mg/m2 over a 120-hour continuous infusion, or CBDCA 400 mg/m2 over a 24-hour continuous infusion on day 1 and FU with the same schedule. Both regimens were repeated every 21 days. The patients received three courses of chemotherapy, excluding those who failed to achieve a partial response (PR) after the second course. Complete responders were treated with radiotherapy. The remaining patients underwent surgery if the tumor was resectable. RESULTS: Interim analysis was performed when 95 patients were included. The trial was stopped due to significantly better results in the control arm. Differences in response (P = .04) were favorable to CDDP-FU. Hematologic toxicity predominated in the CBDCA-FU arm (P < .001). Mucositis and vomiting predominated in the CDDP-FU arm (P = .03, P < .001, respectively). Favorable outcomes (complete response [CR] plus any grade of toxicity and PR plus grade 0 to 3 toxicity) predominated in the CDDP-FU arm (P = .02). Only the treatment assigned was associated with response (P = .02) and favorable outcomes (P = .009) in the logistic regression analysis. In the CDDP-FU arm, disease-free and overall survival were significantly better. Cox regression analysis showed that only treatment association with disease-free survival remains significant. CONCLUSION: Our results indicate that CDDP-FU is more effective than CBDCA-FU as neoadjuvant treatment in stage IV-M0 head and neck cancer.

[Esthesioneuroblastoma: experience from 4 cases treated with radiotherapy and neoadjuvant chemotherapy]. / Estesioneuroblastoma: experiencia en cuatro casos con radioterapia y quimioterapia neoadyuvante.

The esthesioneuroblastoma is an uncommon but curable disease in a high proportion of cases. The treatment is controversial. Radiotherapy, alone or combined with surgery, has demonstrated to be an effective treatment in early stages. Chemotherapy, associated to radiotherapy, can improve the outcome in advanced stages and reduce the morbidity related to surgery. Three cases treated with radiotherapy, and one case treated with chemotherapy followed by radiotherapy are reported. Diagnosis and treatment management are discussed.

Male breast cancer. Report of a series of 50 cases.

Fifty consecutive cases of male breast cancer (MBC) treated in a single institution were studied. Presentation of the disease, histology, pattern of relapse, and major prognostic factors were similar to those known in female breast cancer (FBC). Five-year disease-free interval and survival were 59% and 75% respectively. Endocrine therapy for treatment of metastatic MBC was proven to be effective with a response rate of about 50% of patients, unselected with regard to oestrogen receptors. A group of patients receiving adjuvant treatment showed lower recurrence rate and a trend toward better outcome than similar stage patients without adjuvant treatment. The present study combined with the recent literature suggests that MBC and FBC are biologically comparable and that inference from experience in treatment of FBC may be justified.

CHOP chemotherapy of intermediate and high-grade non-Hodgkin's lymphoma.

The results of CHOP treatment in 63 patients with intermediate and high-grade non-Hodgkin's lymphoma (Working Formulation D to I), Ann Arbor stage I to IV were analyzed. The response rate was 87%, 71% complete remission and 16% partial remission with a mean duration of 22 months. The 5-year actuarial survival was 61% (95% confidence interval, 51-70%). The treatment was well tolerated and no deaths due to acute toxicity were observed. Poor prognostic factors in univariate analysis were: high-grade histology, stages III and IV, B symptoms, > or = 4 affected lymph node regions, Karnofsky index < or = 70, erythrocyte sedimentation rate (ESR) > 60 mm, haemoglobin < 100 g/l and elevated lactic dehydrogenase (LDH). Poor prognostic factors in multivariate analysis were: high-grade histology, stages III and IV, haemoglobin < 100 g/l and elevated LDH. In summary, good results were obtained with CHOP chemotherapy, without severe toxicity.

Detection of doxorubicin cardiotoxicity in patients with sarcomas by indium-111-antimyosin monoclonal antibody studies.

To assess myocardial cell damage due to doxorubicin cardiotoxicity, we prospectively studied 30 patients with sarcomas who were receiving chemotherapy, including doxorubicin. Sixteen patients were treated by continuous infusion over 72 hr and 14 patients were treated by bolus injection. Antimyosin studies and left ventricular ejection fraction (LVEF) measurements were performed before chemotherapy and at intermediate and maximal cumulative doses. Myocardial antimyosin uptake was quantified by a heart-to-lung ratio (HLR). Myocardial antimyosin uptake was observed in all patients at 240-300 mg/m2 when ejection fraction was still maintained. Seven patients presented with a decrease of > or = 10% in absolute ejection fraction units at 420-600 mg/m2. Five of these patients had mild congestive heart failure. All patients who presented with a decrease in LVEF > or = 10% at 420-600 mg/m2 had increased antimyosin uptake with HLR > or = 1.90 at a cumulative dose of 240-300 mg/m2. Patients who were treated with continuous infusion had less antimyosin uptake than those who were treated with bolus administration (mean HLR of 1.70 +/- 0.09 versus HLR of 2.01 +/- 0.16 at a cumulative dose of 240-300 mg/m2, p < 0.01; HLR of 1.86 +/- 0.12 versus HLR of 2.32 +/- 0.34 at a cumulative dose of 420-600 mg/m2, p < 0.01). Two of 16 patients treated by continuous infusion and 5 of 14 patients treated by bolus injection presented with a decrease in ejection fraction > or = 10%. LVEF after chemotherapy in the infusion group was 56% +/- 5% and 48% +/- 8% (p < 0.05) in the bolus group. Antimyosin studies are helpful in the assessment of doxorubicin cardiotoxicity. Intense antimyosin uptake at intermediate cumulative doses identifies patients at risk of cardiotoxicity before ejection fraction deteriorates. Patients with sarcomas treated by continuous infusion present with less antimyosin uptake than those treated with bolus injection, indicating less severe cardiotoxicity.

Treatment of stage I testicular tumours.

Between 1980 and 1989, 138 patients with stage I carcinoma of the testes were treated and followed up; 81 patients had seminoma and 57 had non-seminomatous tumours. Between January 1980 and December 1983, patients with seminoma were treated by orchiectomy, followed by complementary radiotherapy to aortic and ipsilateral pelvic nodes. Retroperitoneal lymph node dissection (RPLND) was performed in patients with non-seminomatous tumours. After January 1984 the treatment strategy was changed and orchiectomy was followed by a surveillance policy in all histological types. In seminoma patients, 1 of 36 patients (3%) treated with complementary radiotherapy and 5 of 45 (11%) on the surveillance policy relapsed. All achieved a complete response after chemotherapy. In non-seminomatous tumours, 3 of 21 patients (14%) treated with complementary lymphadenectomy relapsed, in contrast to 11 of 36 (31%) surveillance policy patients. All patients who relapsed obtained a complete response with chemotherapy. All patients are currently free of disease. There were no differences in survival between both treatment policies. We conclude that a wait and see policy in stage I testicular tumours is feasible and provides the same results as more interventionist practices.

[The treatment of carcinoma of the pyriform sinus at Santa Creu I Sant Pau Hospital of Barcelona. The role of surgery]. / Tratamiento del carcinoma del seno piriforme en el Hospital de la Santa Creu I Sant Pau de Barcelona: papel de la cirugía.

The paper deals with the retrospective review done by the AA. about the treatments used for squamous carcinomata of the pyriform sinus at Santa Creu i Sant Pau Hospital, Barcelona, between the years 1984-1990. In this term 76 sinus pyriform carcinomata were diagnosed, 12 of which (16%) were managed palliatively. In the other 64 cases radical treatment was advised and followed: 5 cases underwent radical cobalt-therapy; polychemotherapy followed by radiotherapy in 27; surgery plus radiotherapy in 7; and polychemotherapy completed with surgery and radiotherapy in the remaining 25 cases. Considerations on the realized pharyngectomies and their reconstructive steps and complications are commented. Inventory and end results in each group are reported. The beneficial local influence was evident when surgery was employed (100% with surgery plus radiotherapy and 92% with polychemotherapy, surgery and radiotherapy). Local control was inferior if surgery was discarded (20% in radiotherapy and 37% by polychemotherapy followed by radiotherapy). Actuarial survival for the lump sum amounted for the 40 percent after 5 years follow-up. It must be emphasized that these groups are not comparable because the choice treatment in each case was indicated in view of the initial stage.

A phase II trial of carboplatin in untreated patients with extensive stage small cell lung cancer.

Twenty-five untreated patients with extensive stage small cell lung cancer (ESSCLC) were treated with carboplatin (CBDCA) (500 mg/m2) given as a 24-hour infusion every 21 days. Thirteen patients responded for an overall response rate of 52% (95% confidence limits, 32% to 72%) with 3 complete responses (CR) (12%; 95% confidence limits, 0% to 25%). The median duration of response was 4.5 months. The median survival time was 8 months with three long-term survivors (12%) at 27, 33, and 43 months from the start of CBDCA treatment. Ninety-two courses of CBDCA were administered and one treatment-related death occurred. The main toxicity was myelosuppression. Grade 3 or 4 hematologic toxicity (hemoglobin level, less than 8 g/dl; granulocyte count, less than 1900/microliters; and platelet count, less than 49,000/microliters) was observed as follows: neutropenia in 7 courses (8%) and in 7 patients (28%), decreased hemoglobin level in 13 courses (15%) and in 7 patients (28%), and decreased platelet count in 10 courses (11%) all Grade 3 and in 8 patients (32%). This study demonstrates that at this dose and schedule CBDCA is a highly active drug in ESSCLC and it has tolerable toxicity.

Assessment of anthracycline-induced myocardial damage by quantitative indium 111 myosin-specific monoclonal antibody studies.

To assess chemotherapeutically induced myocardial damage, myosin-specific antibody scans and ejection fraction measurements were performed in 32 patients with breast cancer and in 9 patients with other tumours. All patients had received chemotherapy including anthracyclines. The ejection fraction decreased by less than or equal to 10% in 14 of 41 (34%) patients after chemotherapy. Antimyosin uptake in the myocardium was observed in 38 of 41 (92%) patients after chemotherapy. Antimyosin uptake was quantified by means of a heart-to-lung ratio, revealing a correlation between the degree of antimyosin uptake in the myocardium and the cumulative dose of anthracycline. Patients with a decreased ejection fraction showed more intense antimyosin uptake, indicating more severe myocardial damage. A higher degree of antimyosin uptake was found in 17 breast cancer patients treated with doxorubicin compared with 15 patients treated with mitoxantrone. We conclude that antimyosin studies provide a sensitive, non-invasive method to monitor myocardial damage in patients treated with anthracyclines. Antimyosin uptake in the myocardium precedes ejection fraction deterioration. This technique may be helpful in the early identification of patients at risk of congestive heart failure during chemotherapy including anthracyclines.

[Chondrosarcoma of the larynx: review of the Western literature and presentation of a new case]. / Condrosarcoma laríngeo: revisión de la literatura occidental y presentación de un nuevo caso.

We present the case of a 70 year old man with cricoid chondrosarcoma treated with total laryngectomy. This report reviews the occidental literature, with nine cases reported by national authors in the las 25 years. We have recollected 104 laryngeal chondrosarcoma, in all. Clinical and diagnostical data, location, and treatment were analysed and compared with our case.

Ultrasonic patterns observed in hepatic metastases from breast carcinoma: diagnosis and evolution.

A retrospective analysis was made of 78 patients presenting breast neoplasm with hepatic metastases confirmed by ultrasound. Clinical hepatomegaly was present in 61%. The serum glutamic-oxaloacetic transaminase (SGOT) was elevated in 72%, the serum glutamic-pyruvic transaminase (SGPT) in 56%, the serum alkaline phosphatase (Aph) in 86%, and the gamma-glutamil transpeptidase (GGT) in 76%. A hypoechogenic multiple nodular pattern (HMN) was observed in 69%, a diffuse hypoechogenic pattern (DH) in 15%, and a mixed multiple nodular pattern (MMN) in 11%. No single nodular pattern was presented in any patient. The univariate analysis showed a better survival rate in patients with a mixed pattern (mean 11 months, range 1-29 months) (p = 0.027). No significant differences were observed regarding the remaining patterns, age, presence or not of hepatomegaly, or altered enzymatic values.